Terence van Arkel, VP/ Chief Financial Officer Tanya Simpson, RN, MS - Assistant Vice President Doctors Hospital

Transcription

1 Terence van Arkel, VP/ Chief Financial Officer Tanya Simpson, RN, MS - Assistant Vice President Doctors Hospital

2 Objec&ves Why Burn Centers should be part of a World Class State-wide Trauma System. Educate trauma commission on the operational facts and attributes of the Joseph M. Still Burn Center at Doctors Hospital- Augusta, Georgia.

3 Doctors Hospital Burn Unit Verified by the ABA/ACS Valida<ng our compliance with the Standards of Care 2/11/2010

4 Why Include the Burn Center in the Network? Doctors Hospital Burn Center cares for 68% of all burn patients in the state. Research has proven patient outcomes are better when treated in a specialized burn center. Carter, J.E, Neff, L.P, Holmes, J.H. Adherence to Burn Center Referral Criteria: Are Patients Appropriately Being Referred?, Burn Care and Research 2010; 31: Trauma designation standards do not require that a designated facility treat burn patients, only that there is a transfer agreement with a hospital with a burn center. Burn Center currently receives 3 patient transfers a week from trauma centers around the state (Level I Level IV). Currently, Burn Center removes the burden of treating burn patients from other Trauma centers without access to reimbursement for uncompensated care patients or readiness costs. Burn center has the resources in place to meet Level II criteria, per designation standards, as they relate to the care of burn trauma patients. Currently meet designation requirements : quality programs, research, peer review, outreach education and prevention and physician/staff educational requirements. (Crosswalk hand out provided). Doctors Hospital is the only hospital in the state with a trauma service line that is verified by the American College of Surgeons.

5 Na<onal Burn Sta<s<cs 2.4 million burn injuries occur per year 650,000 seek medical treatment 75,000 are hospitalized 20,000 have burns > 25% TBSA 8,000 12,000 will die from burn injury

6 Burn Center Facts National Statistics There are 125 Burn Centers in the United States Average Burn Center in US size is 15 beds From , there were 127,016 burn patients treated in Burn Centers nationally. 71% of burn patients are male Mean age for all cases is 32 years old Most common etiologies of burns are flame burns in adults and scald burns in children Pneumonia is the most frequent complication of a burn injury

7 Georgia Sta<s<cs 89 fire deaths in of these fire deaths were children - 28% In 2008 there were 1,410 burn injuries that occurred in Georgia, serious enough to require hospitalization in a Burn Center

8 Mechanism of Burn Injury Fire/Flame: 40% Scald: 30% Contact with hot object: 8% Electrical: 4% Chemical: 3% Other: 15% American Burn Association 2008 National Burn Repository Data

9 Doctors Hospital Joseph M. Still Burn Center Statistics Founded in 1978, by Dr. Joseph M. Still, we have served burn victims throughout the Southeastern US for over 30 years. Largest Burn Center in the country with 70 designated burn beds, treating 3,000 in- patients annually. Treat 12,000 patients annually in our Wound and Burn Outpatient Clinic. Average Daily Census of 45 over last two years (76% Occupancy). Provide quality patient care to all we serve regardless of funding

10 State Burn Market Share Data Facility Cases Market Share Cases Market Share Cases Market Share Doctors Hospital of Augusta 1, % 1, % 1, % 1, % 1, % 1, % Grady Memorial Hosp/Grady Health System % % % Memorial Health University Medical Center % % % Southeast Georgia Health System, Brunswick Campus % % % South Georgia Medical Center % % % Hamilton Medical Center, Inc % % % Washington County Regional Medical Center % % % John D. Archbold Memorial Hospital % % % Childrens Healthcare of Atlanta At Egleston % % % Henry Medical Center, Inc % % % Floyd Medical Center % % % % % % % % % 1, % 1, % 1, %

11 Doctors Hospital of Augusta Burn Inpa<ent Admission Payer Mix Ga Residents Jan 2010 Nov 2010 Facility Total Cases Total % of Total Payor Group BCBS % Commercial % Managed Care % Medicaid % Medicaid Mgd Care % Medicare % Medicare Mgd Care % Other % Other Govt % Self Pay/Charity % Workers Comp % Grand Total 1, %

12 Georgia Trauma Centers - Excludes DHA Burn Pa<ents Trauma Payer Mix (Georgia Residents Only) Trauma Inpatients* Total Cases Total % Down Payor Group BCBS % Commercial 1, % Managed Care 1, % Medicaid % Medicaid Mgd Care % Medicare 2, % Medicare Mgd Care % Other % Other Govt % Self Pay/Charity 1, % Workers Comp % Grand Total 9, %

13 Burn Transfers to Doctors Hospital Burn Center from Designated Trauma facili<es in Georgia Jul 01, 2009 Jun 30, 2010 Level I Medical College of Georgia 20 Medical Center of Central Georgia 29 Memorial Health, Savannah 28 Level II 1 year Total 77 Archibald Memorial 8 Grand Total of 169 pa0ents Athens Regional 22 transferred to the Joseph M. Medical Center Columbus 15 Burn Center from designated Floyd Medical Center 18 trauma centers in one year. Gwinnet Medical Center 4 Hamilton Medical Center 15 North Fulton Regional 4 Level IV Total 86 Morgan Memorial 6

14 Doctors Hospital Quality Indicators Better than National Averages Survival Rate Length of Stay Infection Rates Bloodstream Infections Urinary Tract Infections Ventilator Associated Pneumonia

15 Doctors Hospital Burn Center Indicators Survival Rate DHA: 97% Survival Rate National: 95% Survival LOS DHA: 0.76 days/%tbsa (TBSA-total burn surface area) LOS National: 1.0 day/%tbsa

16 Doctors Hospital Burn Services Dedicated Human Resources 5 Full-time Burn Surgeons and 2 Part-time surgeons 17 Mid Level Practitioners (Nurse Practitioners and Physician Assistants) 24 hour Burn dedicated Adult Intensivists and Pediatric Intensivists 2 Burn Educators - Provide ongoing staff competency education - Provide certifications in ACLS, ABLS, & PALS for all Burn staff 2 Full-time Social Workers and 4 Full-time Case Managers dedicated to Burn Services 18 Physical and Occupational Therapists dedicated to Burn Services Full-time, dedicated Clinical Pharmacist for the BICU Full-time Child Life Specialist for Burn Services > 185 Burn Nurses - 26% Nursing staff > 10 years burn experience - Burn Fellowship Program to train new nurses in burn care and burn critical care Burn specialty OR teams and anesthesia 35 Burn Technicians with burn specific training Full-time Data Coordinator (TRACS) Burn Registry

17 Commitment to Ongoing State of the Art Technology and Care renova<on and expansion to include: New 20 bed private room burn ICU designed to meet the special needs of a major burn trauma patient. All rooms are temperature controlled, have new cardiac monitors, beds with specialty mattresses to reduce pressure and Infection Control and prevention stations. 70 Beds Dedicated to Burn Services. New Advanced Wound and Burn Outpatient Clinic includes 16 treatment rooms and 4 fully monitored procedure rooms Burn Center ambulance entrance 2 bay receiving/admission room Burn Pre-op suite 4 Burn operating suites Staff lounge and EMS workroom Inpatient family waiting room Outpatient waiting room and registration

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19 Complexity of Care

20 Equipment/Special Needs for Burn Trauma Patients at Doctors Hospital Specialized equipment available to care for the critically injured burn patient includes: Ventilators multiple type for various modes of ventilation Multiple IV Pumps (i.e.. 20 infusions) Rapid Infusers Cardiac/Hemodynamic Monitoring Dialysis (Hemodialysis and CRRT) Nutritional (Duodenal Tube Feedings) Low air loss specialty surface Warmers (body and fluid) Thermo-regulated rooms Whirlpool/Hydrotherapy Dermatomes/Meshers/Bovies Traction Devices Isolation capability Hyperbaric Chambers

21 Complexity of Equipment

22 Commitment to Follow- up Care Advanced Wound and Burn Clinic at Doctors Hospital 20 bed outpatient facility opened in Jan 2010 Comfortable waiting facilities and private registration areas State of the art monitoring equipment, hydrotherapy, and hyperbaric treatment alternatives Dedicated, wound care certified staff including PT/OT therapists. Lymphedema management Easy access to burn outpatient services

23 Commitment to Families Partnering with the Southeastern Firefighters Burn Foundation allows us to care for families under stress by: Providing on campus housing at the Shirley Badke Retreat capacity of 50 family members Coordinating local churches and civic organizations to bring daily meals to the waiting room Sponsors educational sessions and support groups for families while their love one is hospitalized

24 Commitment to Research Joseph M. Still Research Foundation The Research Program allows us to provide cutting edge technology. Typically 8-12 research studies are in progress at all times. Burn dressings/topicals Anti-infective agents ARDS drugs Anti-fungal agents Medical Devices Physician CEO Carlos Blanco

25 Commitment to Burn Outreach Education and Prevention Medical Education JMS Burn Symposium annually Emergency Burn Care Lectures to nursing schools, EDs, EMS ABLS Courses (Conduct 6-12 annually) Burn Care Commentary produced bi-annually and mailed to 20,000 ED and Trauma physicians throughout the Southeast Community Prevention Education Burnie mascot Safety Program for pre-school and school-age children Health Fair Burn Prevention Displays

26 Success Based on: Experience and Resource Availability Proven Quality Outcomes 32 years experience and dedication to Burn care Streamlined referral process. ED physicians will speak immediately and directly to burn surgeon for transfer and emergent care guidance Rapid transport from ED or the scene to the Burn Center On-campus capability to house family members at the Shirley Badke retreat State of the art equipment and treatment options Fully integrated multi-disciplinary team

27 ABA Referral Criteria A burn unit may treat adults or children or both. Burn injuries that should be referred to a burn unit include the following: 1. Partial thickness burns greater than 10% total body surface area (TBSA). 2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints. 3. Third-degree burns in any age group. 4. Electrical burns, including lightning injury. 5. Chemical burns 6. Inhalation burns 7. Burn injury in patients with pre-existing medical disorders that could complicate management, prolong recovery, or affect mortality. 8. Any patient with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be necessary in situations and should be in concert with the regional medical control plan and triage protocols. 9. Burned children in hospitals without qualified personnel or equipment for the care of children. 10. Burn injury in patients who will require special social, emotional or long-term rehabilitative intervention. Excerpted from Guidelines for the Operations of Burn Units (pp ), Resources for Optimal Care of the Injured Patient: 1999, Committee on Trauma, American College of Surgeons.

28 Questions??